Surgical technique for atrial-esophageal fistula repair after catheter ablation: An underrecognized complication

Guenthart, Brandon A.; Sun, Beatrice J.; Biasi, Andreas de; Fischbein, Michael P.; Liou, Douglas Z.

doi:10.1016/j.xjtc.2020.07.022

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…Two-stage approach using intra-cardiac repair and esophageal repair has several disadvantages. It not only needs a cardiopulmonary bypass, but also needs position change of the patient [7]. Another hybrid technique [8] including intra-cardiac repair and an endoscopic clipping has a risk for possibility of failure of the clipping procedure and the need for thoracic operation in case of re sulization.…”

Section: Discussionmentioning

confidence: 99%

One step thoracotomy approach for atrial-esophageal fistula repair without cardiopulmonary bypass

Lee

Yoon

Hong

et al. 2022

Preprint

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Although atrial-esophageal fistula is an extremely rare disease, it is a life-threatening complication after catheter ablation for atrial fibrillation. There is no consensus on management or repair for atrial-esophageal fistula which has a high mortality rate. Here, we describe a lateral thoracotomy approach focused on simplifying the repair procedure for atrial-esophageal fistula with two cases. Two male seniors in their 60s and 70s, respectively, who had undergone catheter ablation for atrial fibrillation presented to the emergency department with fever and mental decrease. Blood culture confirmed Streptococcal bacteremia. Brain magnetic resonance imaging showed multiple cerebral infarcts. After demonstrating atrial-esophageal fistula with computed tomography of chest, an emergency operation was planned. The two patients were placed in the right down decubitus position with single lung ventilation. A lateral thoracotomy was performed on the left 5th intercostal space. Multiple pledgeted 4-0 prolene sutures for ligation were paced on the fistula of the pericardial side. From the esophageal side, a fistulectomy was performed, followed by an additional primary repair for the esophageal defect. Follow-up endoscopy demonstrated a well-repaired fistula site. The two patients were discharged without recurrence. Our experience suggests that one step repair for atrial-esophageal fistula via lateral thoracotomy might be feasible in selected patients.

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Section: Discussionmentioning

confidence: 99%

One step thoracotomy approach for atrial-esophageal fistula repair without cardiopulmonary bypass

Lee

Yoon

Hong

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“… 4 As mentioned by Shen, 2 with the nearly 10-fold rise in performed catheter ablations for the treatment of atrial fibrillation between 2000 and 2013, there will likely be hundreds of AE fistulas yearly. 5 , 6 Given the report presented by Felmly and Gibney 1 and recent trends in electrophysiology, it is clear that prevention of AE fistulas should be a priority for both electrophysiologists and thoracic surgeons alike. 7 AE fistulas present a unique challenge, as they are difficult to diagnose, leading to late management and worsened prognosis, thus demanding proactive safety measures to prevent such a devastating complication.…”

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confidence: 99%

Atrioesophageal fistula—A focus on preventing a devastating complication

2022

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“…In this month's issue of JTCVS , Guenthart and colleagues 1 report their technique for repair of an atrial-esophageal fistula after catheter ablation for atrial fibrillation. The authors provide multiple pearls to navigate the diagnosis and successful repair of this rare, but lethal, complication.…”

mentioning

confidence: 99%